Background: The coronavirus disease 2019 (COVID-19) pandemic has strongly challenged health systems, but Italian community mental health services, rooted in the Basaglia reform and the World Health Organization (WHO) QualityRights framework, may have preserved a high perception of care quality and respect for human rights. This study compared users' perceptions of quality of care, human rights, and resource adequacy in public mental healthcare facilities during and after the pandemic in Sardinia, Italy. Methods: A cross-sectional survey was conducted in 2025 among users attending three community mental health services (Nuoro and Sanluri Local Health Networks) and one university hospital facility (Cagliari). Data were compared with a previous survey carried out in the same network during the COVID-19 pandemic (2021). Users completed a brief sociodemographic form and the "Well-Being at Work and Respect for Human Rights Questionnaire" (WWRR, user version), inspired by the United Nations (UN) Convention on the Rights of Persons with Disabilities and WHO QualityRights. Group differences were analyzed using chi-square tests and one-way analysis of variance (ANOVA). Results: The final 2025 sample included 118 users, compared with 200 users in 2021. Mean satisfaction scores for overall care and organizational aspects (WWRR items 1-3) remained very high in both surveys (>5/6) without significant differences. Perceived respect for users' rights (item 4) and staff rights (item 5) significantly increased post-pandemic (5.26 ± 1.10 vs. 5.51 ± 0.98, p = 0.042; and 4.89 ± 1.22 vs. 5.35 ± 1.04, p = 0.001, respectively). Perception of resource adequacy (item 6, reverse-coded) also improved (2.68 ± 1.10 vs. 2.06 ± 0.98, p < 0.001), although it remained the most critical domain. Item 7 indicated an evolving demand for a more diversified workforce, with psychologists being the most frequently requested professionals, and an emerging perceived need to increase multiple professionals across multiple categories and administrative/management staff. Conclusion: Users of Sardinian community mental health services reported persistently high satisfaction and an increased perception of respect for human rights after the COVID-19 pandemic, despite ongoing concerns about limited resources. These findings highlight the resilience of community-based mental healthcare and underscore the need for structural investment and the strengthening of the multidisciplinary workforce strengthening to sustainably align service provision with international human rights standards.
The perception of quality of care and respect of human rights in mental healthcare facilities among users during and after the pandemic in Sardinia, Italy
Atzeni, Michela;Aviles Gonzales, Cesar Ivan
2026-01-01
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has strongly challenged health systems, but Italian community mental health services, rooted in the Basaglia reform and the World Health Organization (WHO) QualityRights framework, may have preserved a high perception of care quality and respect for human rights. This study compared users' perceptions of quality of care, human rights, and resource adequacy in public mental healthcare facilities during and after the pandemic in Sardinia, Italy. Methods: A cross-sectional survey was conducted in 2025 among users attending three community mental health services (Nuoro and Sanluri Local Health Networks) and one university hospital facility (Cagliari). Data were compared with a previous survey carried out in the same network during the COVID-19 pandemic (2021). Users completed a brief sociodemographic form and the "Well-Being at Work and Respect for Human Rights Questionnaire" (WWRR, user version), inspired by the United Nations (UN) Convention on the Rights of Persons with Disabilities and WHO QualityRights. Group differences were analyzed using chi-square tests and one-way analysis of variance (ANOVA). Results: The final 2025 sample included 118 users, compared with 200 users in 2021. Mean satisfaction scores for overall care and organizational aspects (WWRR items 1-3) remained very high in both surveys (>5/6) without significant differences. Perceived respect for users' rights (item 4) and staff rights (item 5) significantly increased post-pandemic (5.26 ± 1.10 vs. 5.51 ± 0.98, p = 0.042; and 4.89 ± 1.22 vs. 5.35 ± 1.04, p = 0.001, respectively). Perception of resource adequacy (item 6, reverse-coded) also improved (2.68 ± 1.10 vs. 2.06 ± 0.98, p < 0.001), although it remained the most critical domain. Item 7 indicated an evolving demand for a more diversified workforce, with psychologists being the most frequently requested professionals, and an emerging perceived need to increase multiple professionals across multiple categories and administrative/management staff. Conclusion: Users of Sardinian community mental health services reported persistently high satisfaction and an increased perception of respect for human rights after the COVID-19 pandemic, despite ongoing concerns about limited resources. These findings highlight the resilience of community-based mental healthcare and underscore the need for structural investment and the strengthening of the multidisciplinary workforce strengthening to sustainably align service provision with international human rights standards.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
